title: Antifibrinolytic Use and Blood Transfusions in Pediatric Scoliosis Surgeries Performed at US Children's Hospitals.
abstract: METHODS
  Retrospective cohort study using the Pediatric Health Information Systems database.
  
  
  OBJECTIVE
  To determine the association between antifibrinolytic use and red cell transfusions in spinal fusion operations performed at 37 US Children's Hospitals.
  
  
  BACKGROUND
  Evidence from randomized clinical trials and systematic reviews suggests that antifibrinolytic therapy can significantly reduce blood loss in children undergoing scoliosis surgery; however, the effectiveness of these agents as used in surgeries performed at US children's has not been studied.
  
  
  METHODS
  We included children aged 0-18 years with diagnoses indicating adolescent idiopathic scoliosis (AIS) or neuromuscular scoliosis (NMS) for whom a spinal fusion procedure was performed between January 1, 2006 and September 30, 2009. Patients with malignancy, trauma, coagulation disorders, or for whom a cell salvage device was employed were excluded. Multilevel logistic regression was used to determine associations between ε-aminocaproic acid (EACA), tranexamic acid (TXA), and aprotinin (APR) use and blood transfusions, controlling for patient and surgery characteristics.
  
  
  RESULTS
  Cohorts consisted of 2722 AIS and 1547 NMS procedures. Antifibrinolytic use varied across hospitals (AIS 3.3%, interquartile range, 0%-42%; NMS 12 interquartile range, 0%-46%), and was significantly associated with NMS, posterior fusion, number of vertebrae fused. Overall, 15% of children received EACA, 7% TXA, and 2% APR. The median hospital-specific rate of red cell transfusions was 24% for AIS and 43% for NMS. In AIS operations, EACA use, but not TXA use, was associated with significantly lower odds of transfusion (odds ratio, 0.42; P<0.001 vs. odds ratio, 1.0; P=0.8). In NMS operations, neither EACA nor TXA use was associated with a decrease in odds of red cell transfusions.
  
  
  CONCLUSIONS
  The effectiveness of antifibrinolytics as used outside of clinical trials is unclear and should continue to be explored. Future prospective research is needed to evaluate which administration protocols will most benefit patients, as well as to determine the comparative effectiveness of these drugs in the context of other blood conservation strategies.
authors.affiliation: *Pediatric Hospital Medicine, Children's Hospital of Colorado, Section of Hospital Medicine, Aurora, CO †Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania ‡Division of Orthopedic Surgery, Children's Hospital of Philadelphia §Department of Orthopedic Surgery, Perelman School of Medicine, University of Pennsylvania ∥Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia ¶Department of General Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: McLeod
authors.forename: Benjamin
authors.initials: B
authors.lastname: French
authors.forename: John M
authors.initials: JM
authors.lastname: Flynn
authors.forename: John P
authors.initials: JP
authors.lastname: Dormans
authors.forename: Ron
authors.initials: R
authors.lastname: Keren
mesh_terms: D000293:Adolescent; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D005260:Female; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D012600:Scoliosis / Q000601:surgery*; D014481:United States
chemical_list: D000933:Antifibrinolytic Agents